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Minimally invasive options in the treatment of saphenous varicose veins



Abstract

Varicose vein is a commonly seen condition in general practice. Patients seek medical advice for cosmetic and health concerns. Duplex ultrasound is becoming an essential tool for evaluating patients with venous disease. Treatment options for saphenous varicose veins are progressing and becoming less invasive. Besides open surgery with ligation and stripping, saphenous varicose veins may now be treated with endovenous ablation techniques including radiofrequency ablation (RFA) or endovenous laser therapy (EVLT). The introduction of ultrasound-guided foam sclerotherapy (UGFS) allows for effective treatment of saphenous veins, perforating veins, and larger varicose tributaries. As techniques continue to evolve, varicose tributaries. As techniques continue to evolve, varicose veins can be treated at an earlier stage, with patients enjoying shorter recovery times, an earlier return to work, and better cosmetic outcomes. Minimally invasive therapy has strengthened the armamentarium of surgeons in the modern management of varicose veins.



Introduction

New technologies and improvements in established methods have had dramatic effects in the manner in which superficial venous diseases are diagnosed and treated. The development of ultrasound imaging techniques in the 1970s followed by the addition of colour flow Doppler allowed doctors to gain a better understanding of venous physiology and pathophysiology, from which the advances in minimally invasive treatment derive.

This paper will review the three techniques currently in use for the treatment of varicose vein resulting from superficial venous reflux (Figure 1); namely ultrasound-guided foam sclerotherapy (UGFS), endovenous laser therapy (EVLT), and radiofrequency ablation (RFA).

The objective of this review is to inform clinicians about the commonly used minimally invasive therapies for truncal varicosities, to describe the procedures, and to review their efficacy and safety. Description of the classification of chronic venous disease will be discussed in the next issue.



Duplex Ultrasound

The most important imaging study for patients with varicose veins is the duplex ultrasound (Figure 2). B-mode ultrasound imaging is done using a high frequency, usually 7.5-10 MHz, transducer. Colour flow scanners allow direct visual representation of flow with a change of colour from red to blue depending on whether the flow is toward or away from the probe. Duplex imaging is usually done for the deep veins to exclude any problems with old occlusive disease or reflux in the deep veins. The great and small saphenous veins are examined for patency and reflux. Also, the perforating veins are examined to check that there is normal flow from superficial to deep veins. Reflux is best demonstrated with the patient in the standing position.







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